Illinois Senate Bill 1390

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Spectrum: Bipartisan Bill
Status: Introduced on January 29 2025 - 25% progression
Action: 2025-02-04 - Added as Co-Sponsor Sen. Steve McClure
Pending: Senate Assignments Committee
Text: Latest bill text (Introduced) [HTML]

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall not enter into a contract with a managed care organization that relies on a pharmacy benefit manager that does not do the following: (i) utilize a pharmacy reimbursement methodology of the lesser of national average drug acquisition cost plus a professional dispensing fee as determined by the Department, the wholesale acquisition cost plus a professional dispensing fee as determined by the Department, or the usual and customary charge by the pharmacy; (ii) reimburse for a legally valid claim at a rate not less than the rate in effect at the time the original claim adjudication was submitted at the point of sale; (iii) agree to move to a transparent pass-through pricing model, in which the pharmacy benefit manager discloses the administrative fee as a percentage of the professional dispensing costs to the Department; (iv) agree to not create new pharmacy administration fees and to not increase current fees more than the rate of inflation; and (v) agree to not terminate an existing contract with a pharmacy licensed under the Pharmacy Practice Act for the sole reason of the additional professional dispensing fee authorized under item (i). Requires each pharmacy benefit manager that receives reimbursement for medical services, either directly or through a Medicaid managed care health plan, to submit by January 15, 2027, and each January 15 thereafter, certain data and information to the Department for the previous fiscal year, including: (1) the total number of prescriptions that were dispensed; (2) the aggregate wholesale acquisition cost for each drug on its formulary; (3) the aggregate amount of rebates, discounts, and price concessions that the pharmacy benefit manager received for each drug on its formulary; (4) the aggregate amount of administrative fees that the pharmacy benefit manager received from all pharmaceutical manufacturers; and (5) any other information considered necessary by the Department. Requires the Department to submit such data and information to the General Assembly and to the Governor's Office of Management and Budget. Provides that such information is confidential and not subject to disclosure under the Freedom of Information Act.

DHFS-MCO-PBM-CONTRACTS

Sen. David Koehler [D]

Sen. Steve McClure [R]

Date	Chamber	Action
2025-02-04	Senate	Added as Co-Sponsor Sen. Steve McClure
2025-01-29	Senate	Referred to Assignments
2025-01-29	Senate	First Reading
2025-01-29	Senate	Filed with Secretary by Sen. David Koehler

Chapter	Article	Section	Citation Type	Statute Text
305	5	5-36a	New Code	See Bill Text

Type	Source
Summary	https://www.ilga.gov/legislation/BillStatus.asp?DocNum=1390&GAID=18&DocTypeID=SB&SessionID=114&GA=104
Text	https://www.ilga.gov/legislation/104/SB/10400SB1390.htm